Uterus transplant risky, raises ethical debate

In exactly three weeks, womb transplant will be a reality in India. A Pune hospital is all set to carry out the country’s first set of uterine transplants, fitting three women with the wombs of their mothers. A successful womb transplant will allow them to bear their own children. Pune’s Galaxy Care Laparoscopy Institute (GCLI) has been granted a licence by the state’s directorate of health services to carry out the uterus transplant–a much-debated surgery attempted the world over with limited success.

Around 25 procedures have been attempted, but less than 10 successful post-transplant pregnancies are known. The first one was in Sweden in 2014 (see box, P 2). The Pune live donor uter ine surgeries are scheduled for May 13 and 14. GCLI medical director and oncosurgeon Shailesh Puntambekar said they have been aspiring to carry out the challenging surgery since they learned about Sweden’s success. “A meticulous process was followed to choose the three donors and recipients,” he said. Pune’s Galaxy Care Laparoscopy Institute (GCLI) is likely to beat Bengaluru’s Milann International Institute for Training and Research in Reproductive Health in the race to perform the country’s first uterine transplant. The latter recently got a go-ahead from the Indian Council of Medical Research (ICMR) to do the transplant for two women out of the nine they had shortlisted. The fertility centre has tied up with the pioneer of uterus transplant, Dr Mats Bronnstrom of the University of Gothenburg in Sweden.

GCLI’s Puntambekar and his team first practised on human cadavers in Tubungen in Germany and in the US. “Later we met the Swedish team credited with the first transplant and spent a few days learning the actual protocol,” he said.
Of the three Pune candidates, one has a congenital absence of uterus. “Another one suffers from scarring (adhesions) of the uterus (Asherman’s syndrome) and the other woman’s uterus was removed due to cancer. The donors are their own mothers and the first transplants are going to be conducted for free,” said Puntambekar, who has to his name the highest number of laparoscopic radical hysterectomies in the world.

The state’s first licence for uterus transplant has been granted for five years. “Our prime concern would be to ensure that the donor is someone who has completed a family and is donating with an altruistic motive,” said Dr Gauri Rathod, the nodal officer for organ transplant.

A spokesperson from the Bengaluru facility told TOI that they would be carrying out the procedures as part of a clinical trial. “We are very close to carrying out the first two cases. We had a stringent inclusion and exclusion criteria as per the centre in Sweden, who would be hand holding us to carry out the transplants,” the spokesperson said.

Preparations for the transplant have been going on in Pune for months. The recipient is made to undergo ovulation stimulation by pre-planned IVF. The frozen embryos are kept ready for implantation, if the transplant is successful. Simultaneously, a course of immunosuppresant is started to bring down chances of rejection of the uterus. The donor too is prepped for hysterectomy.

The transplant, involving multiple surgeries is fraught with risks, and has been the subject of an immense debate since the first successful procedure. “There is a larger ethical question in uterus transplants. Should a medical procedure, no matter how revolutionary, be offered if more viable options such as adoption and surrogacy are available?” said infertility expert Dr Hrishikesh Pai, also a member of the Indian Society of Assisted Reproduction. He added that a transplant has to be followed by an IVF procedure. “Later, it is recommended that the recipient again undergoes hysterectomy,” he said.

Puntambekar argued that it gives a woman legal, biological and gestational motherhood. “Though the patient is going to be on immunosuppression drugs, it is not known to cause any harm to the patient or a baby in the womb.” He added that supportive data of kidney transplant patients successfully delivering healthy babies are available.